Provider Demographics
NPI:1689092975
Name:DEMIRJIAN, JENNA (RD)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:DEMIRJIAN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 STATION AVE
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-3923
Mailing Address - Country:US
Mailing Address - Phone:267-970-4613
Mailing Address - Fax:
Practice Address - Street 1:803 STATION AVE
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-3923
Practice Address - Country:US
Practice Address - Phone:267-970-4613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-03
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN003916133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered